Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Participant Pre-Post Feedack	Form and Instruction	New	Available
Form 1 Partner Pre-Post Feedback	Form and Instruction	New	Available
Form 1 My AmeriCorps Portal Award Recipient Survey	Form and Instruction	Unchanged	Available
Form 1 My AmeriCorps Portal Award Recipient Survey	Form and Instruction	Unchanged	Repair queued
Form 1 My AmeriCorps Portal Replacement Member Survey	Form and Instruction	Unchanged	Available
Form 1 My AmeriCorps Portal Member Surveys	Form and Instruction	Unchanged	Repair queued
Form 1 ACC.gov Contact Instrument	Form and Instruction	Unchanged	Available
Form 1 ACC.gov Contact Form	Form and Instruction	Unchanged	Repair queued
Form 1 VISTA Training Survey	Form and Instruction	Unchanged	Available
Form 1 VISTA Training Survey	Form and Instruction	Unchanged	Missing upstream
Form 1 NSCHC Combined Vendor Survey	Form and Instruction	Unchanged	Available
Form 1 National Service Criminal History Checks Combined Vendor Survey	Form and Instruction	Unchanged	Missing upstream
Form 1 VGF and Days of Service Reporting Feedback Questions	Form and Instruction	Unchanged	Available
Form 1 VGF and Days of Service Feedback Form	Form and Instruction	Unchanged	Repair queued
Form 1 National Service Criminal History Checks Training and Resources Survey	Form and Instruction	Unchanged	Available
Form 1 National Service Criminal History Checks Training and Resources Survey	Form and Instruction	Unchanged	Repair queued
Form 1 Public Health AmeriCorps TTA Questions	Form	Unchanged	Available
Form 1 Public Heath AmeriCorps Training and Technical Assistance Questions	Form	Unchanged	Repair queued
Form 1 Public Health AmeriCorps Grantee Survey	Form and Instruction	Modified	Available
Form 1 Public Health AmeriCorps Grantee Survey	Form and Instruction	Modified	Missing upstream
Form 1 PHA Focus Group	Form and Instruction	Unchanged	Available
Form 1 Public Health AmeriCorps Grantee Focus Group	Form and Instruction	Unchanged	Repair queued
0137- Nonsub Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-26	Available
0137- Nonsub Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-26	Missing upstream
Generic Clearance Submission Template.docx	Supplementary Document	Uploaded 2011-04-20	Available
Generic Clearance Submission Template.docx	Supplementary Document	Uploaded 2011-04-20	Repair queued
Generic Clearance Template Part B.docx	Supporting Statement B	Uploaded 2023-03-21	Available
Generic Clearance Template Part B.docx	Supporting Statement B	Uploaded 2023-03-21	Repair queued
Generic Clearance Template Part A.docx	Supporting Statement A	Uploaded 2023-03-21	Available
Generic Clearance Template Part A.docx	Supporting Statement A	Uploaded 2023-03-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
274595	Participant Pre-Post Survey	Form and Instruction	New	Participant Pre-Post Feedack
274594	Partner Pre-Post Survey	Form and Instruction	New	Partner Pre-Post Feedback
269731	My AmeriCorps Portal Award Recipient Survey	Form and Instruction	Unchanged	My AmeriCorps Portal Award Recipient Survey
269731	My AmeriCorps Portal Award Recipient Survey	Form and Instruction	Unchanged
267084	My AmeriCorps Portal Member Surveys	Form and Instruction	Unchanged	My AmeriCorps Portal Replacement Member Survey
267084	My AmeriCorps Portal Member Surveys	Form and Instruction	Unchanged
265671	ACC.gov Contact Form	Form and Instruction	Unchanged	ACC.gov Contact Instrument
265671	ACC.gov Contact Form	Form and Instruction	Unchanged
263770	VISTA Training Survey	Form and Instruction	Unchanged	VISTA Training Survey
263770	VISTA Training Survey	Form and Instruction	Unchanged
263291	National Service Criminal History Checks Combined Vendor Survey	Form and Instruction	Unchanged	NSCHC Combined Vendor Survey
263291	National Service Criminal History Checks Combined Vendor Survey	Form and Instruction	Unchanged
263220	VGF and Days of Service Feedback Form	Form and Instruction	Unchanged	VGF and Days of Service Reporting Feedback Questions
263220	VGF and Days of Service Feedback Form	Form and Instruction	Unchanged
261186	National Service Criminal History Checks Training and Resources Survey	Form and Instruction	Unchanged	National Service Criminal History Checks Training and Resources Survey
261186	National Service Criminal History Checks Training and Resources Survey	Form and Instruction	Unchanged
260703	Public Heath AmeriCorps Training and Technical Assistance Questions	Form	Unchanged	Public Health AmeriCorps TTA Questions
260703	Public Heath AmeriCorps Training and Technical Assistance Questions	Form	Unchanged
260453	Public Health AmeriCorps Grantee Survey	Form and Instruction	Modified	Public Health AmeriCorps Grantee Survey
260453	Public Health AmeriCorps Grantee Survey	Form and Instruction	Modified
260451	Public Health AmeriCorps Grantee Focus Group	Form and Instruction	Unchanged	PHA Focus Group
260451	Public Health AmeriCorps Grantee Focus Group	Form and Instruction	Unchanged

ICR Details

OMB Control No: 3045-0137	ICR Reference No: 202503-3045-002
Status: Active	Previous ICR Reference No: 202303-3045-002
Agency/Subagency: CNCS	Agency Tracking No:
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/27/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/26/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	05/31/2026	05/31/2026
Responses	10,000	0	10,000
Time Burden (Hours)	1,667	0	1,667
Cost Burden (Dollars)	75,248	0	75,248

---

Abstract: This collection of information is necessary to enable AmeriCorps to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

---

Authorizing Statute(s): US Code: 44 USC 3501 et.seq. Name of Law: Paperwork Reduction Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 1367	01/10/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 16955	03/21/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
ACC.gov Contact Form	1	ACC.gov Contact Instrument
My AmeriCorps Portal Award Recipient Survey	1	My AmeriCorps Portal Award Recipient Survey
My AmeriCorps Portal Member Surveys	1	My AmeriCorps Portal Replacement Member Survey
National Service Criminal History Checks Combined Vendor Survey	1	NSCHC Combined Vendor Survey
National Service Criminal History Checks Training and Resources Survey	1	National Service Criminal History Checks Training and Resources Survey
Participant Pre-Post Survey	1	Participant Pre-Post Feedack
Partner Pre-Post Survey	1	Partner Pre-Post Feedback
Public Health AmeriCorps Grantee Focus Group	1	PHA Focus Group
Public Health AmeriCorps Grantee Survey	1	Public Health AmeriCorps Grantee Survey
Public Heath AmeriCorps Training and Technical Assistance Questions	1	Public Health AmeriCorps TTA Questions
VGF and Days of Service Feedback Form	1	VGF and Days of Service Reporting Feedback Questions
VISTA Training Survey	1	VISTA Training Survey

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10,000	10,000	0	0	0	0
Annual Time Burden (Hours)	1,667	1,667	0	0	0	0
Annual Cost Burden (Dollars)	75,248	75,248	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The cost per respondent and cost to Government has been added. These were not required the last time we submitted. The time burden has not changed.

---

Annual Cost to Federal Government: $75,248

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/26/2025

---